| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,934 |
5,732 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
5,828 |
5,645 |
$127K |
| D2740 |
Crown - porcelain/ceramic |
147 |
98 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
1,760 |
1,547 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,125 |
2,098 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,463 |
1,401 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
562 |
272 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,103 |
1,812 |
$27K |
| D0330 |
Panoramic radiographic image |
434 |
421 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
86 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$7K |
| D2950 |
|
38 |
29 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
159 |
149 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
152 |
151 |
$4K |
| D0180 |
|
93 |
74 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
82 |
$1K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$714.00 |
| D9110 |
|
12 |
12 |
$432.00 |
| D9450 |
|
97 |
80 |
$0.00 |